Provider Demographics
NPI:1689812299
Name:JOHNSON, LINDSEY KAYE (LMFT)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:KAYE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:KAYE
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17645 JUNIPER PATH STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7491
Mailing Address - Country:US
Mailing Address - Phone:952-600-8191
Mailing Address - Fax:
Practice Address - Street 1:17645 JUNIPER PATH STE 105
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-7491
Practice Address - Country:US
Practice Address - Phone:952-600-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN2245106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health